Chapter 8 Therapeutic Exercise 195cookie is moved to all areas of the box, causing
the patient to fully use the neck muscles in
active range of motion. No resistance is used at
this point (Figure 8.17).
Rhythmic stabilization
Rhythmic stabilization, as explained in
Chapter 5, is alternating isometric contractions
of opposing (agonist and antagonist) muscles.
Purpose: To strengthen the stabilizer muscles
of the limbs and trunk.
Goal: The muscles of the trunk are engaged
without the patient taking a step.
Technique: This exercise can be made progres
sive for the neuro patient as follows: For the
patient that is unable to support its weight but can
lie in sternal recumbency, gentle perturbations are
applied while encouraging the patient to main
tain this position. Once the patient is able to sup
port itself in a sit position, it is asked to sit tall
(Figure 8.18) while gentle perturbations are
applied. Next, with the patient standing squarely,
the movements are repeated, finally progressing
to having the patient perform the exercise while
standing on an unstable surface.Sit‐up‐and‐beg and beg‐to‐stand
Purpose: Strengthen core and pelvic limb
musculature.
Goal: Complete multiple reps of the exercise
without falling. Swaying is OK.
Technique: The patient is encouraged to sit
squarely to prevent putting abnormal stress on
the stifles. The therapist asks the patient to sit
up. For the patient that is unstable, the therapist
can assist by supporting one foot. Holding the
foot higher gives more support to the patient.
As the patient grows stronger, the foot can be
lowered, encouraging the patient to hold theFigure 8.17 In head‐in‐a‐box the patient is tempted
with food to place their head in all possible positions to
strengthen the neck muscles. This exercise also
strengthens thoracic limbs, pelvic limbs, and trunk by
maintaining balance while constantly shifting weight.
Source: Photo by Whitney Rupp.
Figure 8.18 The tall sit can be made more challenging
by adding perturbations. Source: Photo by Whitney Rupp.